Are "Natural" Hormones Safer?

Bioidentical compounded hormones sound so appealing: derived from botanical products, seemingly free of risks, and created just for your menopause symptoms. But check the facts before you make any decisions.

By Susan Ince

Beware of Saliva Testing

Some compounders test saliva to measure hormone levels and to document the need for bioidenticals, as well as to track how they’re working, so they can tweak the formula every few months. Saliva tests are said to measure the level of "free" hormone, the active form that’s not bound to a carrier protein. "It’s being promoted as more accurate than blood tests but is very unreliable," says endocrinologist Neil Goodman, MD. Even if saliva tests accurately reflected hormone levels, body levels fluctuate so much during the day that it would be hard to know what to make of a single sample. (To compensate, some high-end kits contain enough supplies for four tests during the day.) But here’s the kicker: Even though hormone levels fluctuate, they’re meaningless when considering menopausal symptoms. "Menopausal women with symptoms don’t have different levels than menopausal women without symptoms," Adriane Fugh-Berman says. "You can’t give a doctor the results of lab tests and ask her to tell you which women are having hot flashes. Some people with virtually undetectable estrogen levels sail through menopause with no symptoms. And other women who don’t have low estrogen levels have terrible hot flashes. So there’s no correlation and no ideal level." Not all bioidentical prescribers or makers endorse the saliva tests.

Allergist Steven Hotze agrees that menopausal symptoms, rather than lab tests, are the key to prescribing estrogens: "You don’t get blood tests when you give Premarin — you just give a dose close to what the body produces and see what happens. If you’re thirsty, then we would bring you a drink of water. If you’re still thirsty, we bring another glass — until you are no longer thirsty. In the same way, we replenish the hormones until you feel well," he explains.

What’s Right for You?

Commercial or Compounded?

Taking hormones — from whatever source and in whatever form — is a choice. Some factors to consider:

Try lifestyle changes first. "Low-risk things, such as exercise, may help you get a good night’s sleep and have an easier time with menopausal symptoms. I recommend them way before I consider hormones, whether bioidentical or not," Nananda Col says. Go low. "Whether you try a commercial or a bioidentical compounded hormone, seek the lowest effective dose for the shortest time," says endocrinologist Neil Goodman. How to find it? Col suggests trying the lowest dose for four to six weeks, then moving gradually higher if needed. After a year, try tapering off the hormones and see what happens. Take it for the right reasons. No matter what the type, rely on hormone therapy only for symptom relief, not to achieve vague goals, such as hormone balance or enhanced well-being. Encouraged to try compounded hormones? "Ask if there’s a therapeutically similar commercial product that can deliver the same active ingredient," says pharmacist and internist Bruce Bouts. "If the answer isn’t clear, get a second opinion from an independent pharmacist." If you opt for compounded hormones, "Ask to see the compounding pharmacy’s quality control reports, showing how close its products are to what’s on the label," suggests Jane Murray, MD, a family physician with an integrative medicine practice in Mission, Kansas. Do a reality check. Assume that the safety concerns with compounded hormones are the same as commercial ones until proven otherwise.

Comparing Hormone Costs

Here’s what you can expect to pay if you opt for conventional hormone therapy, notes ob-gyn Wulf Utian.